HomeMy WebLinkAboutHomestead_Cook (3) H. PREPARER
Preparer of the Sales Disclosure Form Title
Donna Zehner Processor
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN,USA 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Jordan S Mays Katherine M Mays
Address(number and street) Address(number and street)
City,state,and ZIP Code 1 ) a //_c City,state,and ZIP Code
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Country Country
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E-mail address -
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Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as
required by law,and is prepared in accordance with IC 6-1.1.5.5.A person who knowingly and intentionally falsifies the value of transferred
real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
Signal of Sp11er Signature f Seller q /
Pri„je Name of Seller Date signed(mm/dd/yyyy) Printe Name of Seller Date signed(mmldd/yyyy)
Jordan S Mays /)2 7L5/ Z UZ/ Katherine M Mays z5 ZIZ5:,zp Z I
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as It appears on conveyance document Buyer 2-Name as It appears on conveyance document
Chance L.Cook
Ad ress(number and street) Address(number and street)
�11 �. C�05 S4
City,state,and ZIP Code City,state,and ZIP Code
-C 1Ac\C:N roj M 47(e LA
Country Country
E-mall address
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Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply: 0
YES NO CONDITION YES NO CONDITION W
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1.Will this property be the buyer's primary W 0 3. Homestead z E Fri
residence? 0 0 4.Solar Energy Heating or Cooling System 8 o H
/2.Does the buyer have a homestead to be vacated O 0 5.Wind Power Device z N t-I
for this residence?If yes, provide address: I\3tri
O Vl 6. Hydroelectric Power Device >
Address(number and street) O Vf 7.Geothermal Energy Heating or Cooling Dg
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City,state,and ZIP Code County
26-13-20-101-000.023-005 0
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Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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